ANSWERS ON QUESTIONS

Main part

Patient A.T. 49 years old, an engineer, turned to the local GP

complaints of episodic increase in blood pressure to 150 / 90-160 / 95 mm RT. Art.,

accompanied by headaches in the occipital region. On the advice of friends

if you feel unwell due to high blood pressure, take 10 mg enalapril.

In addition, in the last 2-3 months I began to notice the appearance of aching pain in the area

calf muscles when walking at a distance of 250-300 meters, stopping at rest.

Considers himself ill for about 2 years, when the above complaints first appeared.

Previously not examined. He does not receive systematic therapy. Maximum BP figures

- 170/100 mm RT. Art. About 10 years ago, duodenal ulcer was detected.

gut, after a course of conservative therapy of exacerbations was no longer. Other

denies chronic diseases. Smokes about ½ pack per day - 30 years. Alcohol

consumes moderately. Family history: mother suffering from coronary heart disease, GB; father died at the age of

62 years from myocardial infarction. There were no operations, injuries.

Upon physical examination, the condition is satisfactory. Integuments and

visible mucous membranes are not changed. Height - 172 cm, weight - 80 kg, BMI - 27 kg / m²

Peripheral lymph nodes are not enlarged. Thyroid gland. In comparative

percussion in the symmetrical sections of the chest sound clear pulmonary.

Topographic percussion - the boundaries of the lungs within normal limits. NPV - 18 per minute. At

auscultation of light vesicular breathing, no wheezing. The boundaries of the heart are not changed.

Heart sounds are clear, 2 tone accent above the aorta. Heart rhythm is correct, interrupted

single extrasystoles. Heart rate - 70 beats per minute, blood pressure - 150/90 mm RT. Art. Stomach

palpation is soft, painless. The liver is not palpable. Bobbing area

kidney is painless on both sides. There are no dysuric phenomena.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. Which group of antihypertensive drugs would you

recommended to the patient as part of combination therapy? Justify your

a choice.

5. What combinations of groups of antihypertensive drugs are contraindicated in this

to the patient?

Situational task 118 [K000456]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

During the medical examination, a woman is 50 years old (weight 98 kg, height 164 cm)

revealed: fasting glycemia - 6.9 mmol / l, in the general analysis of urine (OAM): specific gravity -

1015, yellow, transparent, protein - 0.15 g / l, sugar ++++, red blood cells - 1-2 p / sp, white blood cells

- 3-5 p / sp, epithelium flat - 3-5 in the field of view.

At the time of inspection, complaints are not actively present. Over the last 6 months

periodically noted an increase in blood pressure to 140/90 - 150/95 mm RT. Art. Antihypertensive

did not receive therapy. Family history: mother - 69 years old suffering from hypertension, type 2 diabetes; father -

died at 60, IM. When questioned, the presence of somatic pathology denies.

Denies bad habits.

Objectively: the condition is relatively satisfactory. Body type

correct. BMI - 37 kg / m². Waist circumference - 104 cm. The skin of the usual

colors are clean. Visible mucous membranes are pale pink. Peripheral lymph nodes are not

palpated. The vesicular breathing, no wheezing. NPV - 16 per minute. Heart sounds

clear, the rhythm is correct. Heart rate - 72 per minute. Hemodynamics is stable. HELL - 140/90 mm

Hg. Art. The abdomen is soft, painless in all departments. The liver is along the edge of the costal arch.

The spleen is not palpable. The symptom of striking is negative on both sides.

Physiological administration is normal.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make a plan for examining the patient.

4. The drug of which group of antihypertensive drugs would you

recommended to the patient? Justify your choice.

5. What glucose-lowering drug would you recommend to the patient? Justify

Your choice.

Situational task 119 [K000457]